General Protocol for Laser Bleaching Evaluate the dental condition Review the patient's oral habit and health history, lifestyle, and expectations. Identify the type of stain and confirm the shade with the patient by using the Vita shade guide arranged by the value as B1/A1/B2/D2/A2/C1/C2/D4/A3/D3/B3/A3.5/B4/C3/A4/C4. Discuss existing restoration and conditions (limitations). Take a photographic record (and study models for take-home bleaching trays). Discuss possible treatment sensitivity and other treatment options.  Discuss the combination of office bleaching and home maintenance bleaching. Set-up First-aid kit must contain antioxidants, such as vitamin E and aloe vera, and anti-inflammatories, such as zinc oxide and propylene glycol (Preparation H) in addition to an eye wash bottle. Assemble protection gear: Laser safety eye goggles Large bibs 2" x 2", 3" x 3" gauze, cotton rolls, cheek retractor Rubber dam or paint-on dam (Powerblock [Kreative] or Opaldam [Ultradent]) Assemble preparation Prep kit: Plain pumice paste mixed with 3% hydrogen peroxide and rubber cup Floss, interproximal strips Brushes, water in a cup Etching gel (phosphoric acid 37.5%) Fluoride gel or rinse Extra-fine soflex disks or Shofu polishing disks Bleaching kit: 35% to 50% hydrogen peroxide bleaching gel or pastes, such as Power gel, Hi-Lite, Opalescence Xtra (Ultradent, South Jordan, UT), and Apollo Secret gel. Brushes Mixing pad, spatula Bleaching procedure Begin coronal cleansing with pumice.  Etch enamel for 5 to 10 seconds.  Wipe off, and rinse clean.  Perform isolation. Brush the prepared bleaching medium carefully on the enamel area. Activate laser light. Use the following settings: 0.35 W 10-second duration for HGM Dental 200, 250 mW for LaserMed Accucure 3000 or similar argon laser. Expose each tooth for 10 seconds, then repeat. Each tooth can receive 30 to 60 seconds lasing per application or until the color of the bleaching gel changes (Hi-Lite, blue to white; Power gel, red to clear; Apollo Secret, yellow to clear). Wipe off the used bleaching medium with wet gauze or cotton pellets or brush for interproximal area. Do not rinse with water. Continue to paint on the fresh bleaching medium and activate until done. Wipe off and repeat with the third application. When the third application is done, wipe off the gel, irrigate with water, remove isolation gear, and rinse well for 1 minute with fluoride rinse. Polish the tooth surface with extra-fine polishing disks. Express satisfaction and delight showing the after result, and confirm with the shade guide. Give postoperative care instructions. Take a second photographic record. Provide home bleaching kit (optional when applicable). Additional Considerations Consider covering bicuspid-to-bicuspid area, upper and lower arch. It varies in each individual situation; a single dark tooth or an unevenly colored area will need more applications. Have a team assistant hold another light unit, such as a plasma-arc lamp, to expose only 10 seconds per tooth. This speeds the process. Keep the bleaching compound 0.5 mm away from the gingiva or root surface. Difficult cases (e.g., tetracycline stains) can take five applications, or schedule the patient for an additional bleaching appointment as well as continued treatment with the home bleaching method. The combination of one visit of power bleaching and short-term home bleaching is an effective approach to tooth whitening. Larger teeth with thicker enamel respond more favorably with better results. Small teeth with thinner enamel have less bleaching effect with a higher chance of unfavorable pulpal response. Patients with prior bleaching experience respond to the laser bleaching quickly and more favorably. The patients themselves are the major variables. Exercising established protocols on one may elicit excellent responses and not in another.